The Minnesota Ketamine and Wellness Institute PA

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

THE MINNESOTA KETAMINE AND WELLNESS INSTITUTE PA

Practice address

9325 Upland LN N Ste 370
Maple Grove, MN 55369-4463

Phone

(612) 394-8717

Fax

(763) 432-5721

NPI assigned

Feb 3, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christena Regena Hatcher, CRNA

Title

Cfo

Phone

(612) 394-8717

Specialties & licenses 4

Addresses

Other names 2

• The Minnesota Ketamine and Wellness Institue, P.A. Other name
• The Minnesota and Ketamine Wellness Institute Other name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rebecca Berry, LICSW

  • Clinical Social Worker
  • Saint Paul, MN
  • NPI 1427833342
  Medicare reassignment Care Compare group NPD
• Christy R Hatcher, CRNA

  • Certified Registered Nurse Anesthetist
  • Coon Rapids, MN
  • NPI 1427004050
  Medicare reassignment Care Compare group NPD
• Lindsey Hatcher, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Maple Grove, MN
  • NPI 1801679634
  Medicare reassignment Care Compare group NPD
• Melissa Ann Bollinger-Kinney, M.S.ED LPC

  • Mental Health Counselor
  • Plymouth, MN
  • NPI 1114074028

  Multi-Specialty

  NPD
• Caroline Elizabeth Kading, MA, LMFT

  • Marriage & Family Therapist
  • Eagan, MN
  • NPI 1548839863
  NPD
• Sarah Storrs, M.D.

  • Surgery Physician
  • Saint Paul, MN
  • NPI 1013178300
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629417600000",
    "number": "1003408857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9325 UPLAND LN N STE 370",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694463",
            "telephone_number": "612-394-8717",
            "fax_number": "763-432-5721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9325 UPLAND LN N STE 370",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694463",
            "telephone_number": "612-394-8717",
            "fax_number": "763-432-5721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MINNESOTA KETAMINE AND WELLNESS INSTITUTE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-03",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A",
        "authorized_official_last_name": "HATCHER",
        "authorized_official_first_name": "CHRISTENA",
        "authorized_official_middle_name": "REGENA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "612-394-8717",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Minnesota Ketamine and Wellness Institue, P.A.",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "The Minnesota Ketamine and Wellness Institue, P.A.",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "The Minnesota and Ketamine Wellness Institute",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Anesthesiology Physician in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Anesthesiology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.